Die wichtigsten Studienergebnisse der prim?ren Radiochemotherapie von Kopf-Hals-Tumoren

Primary concomitant and sequential chemoradiation is a commonly used therapeutic strategy for head and neck squamous cell carcinoma. At the annual meeting of the 2012 American Society of Clinical Oncology numerous trial results were presented. A selection of the most important trials will be summarized in this article. This year, several important results from phase III trials—including the long awaited comparison of sequential and concomitant chemoradiation—were demonstrated.     

New aspects of induction chemotherapy for head and neck cancer: POSTASCO 2011

Treatment options of patients with advanced head and neck cancer developed in the last years. Surgical approaches with or without radiotherapy used to be the standard therapy for a long time. Calls for organ preservation, poor overall survival and unsatisfactory quality of life made changes in this therapy regime necessary. Systemical approaches were evaluated, first concepts of platinum-based chemotherapy paired with 5-fluorouracil (PF) made up the basis of induction chemotherapy (ICT). Hypothesized advantage of this regime was improvement in local and distant tumor responsiveness with an acceptable toxicity profile. Further investigations proved the addition of docetaxel (TPF) superior to PF, which presents the gold standard of current induction chemotherapy regimes. Long-term results underlining well-known aspects of this regime as well as new approaches of induction chemotherapy were published at ASCO 2011, including the addition of bioimmunotherapy to radiotherapy, adding nanoparticle-bound albumin to chemotherapy and investigations in toxicity reduction. Further investigations are still made not only to increase survival outcomes and local control but also to improve quality of life by reducing acute and late toxicities.     

Circulating tumor cells in head and neck cancer: clinical impact in diagnosis and follow-up

Metastasis and the associated loss of function of vital organs in the course of the disease is one of the main causes of death in head and neck cancer patients. An earlier and more reliable determination of metastasis and recurrence than currently obtained by common imaging methods could improve therapy and therefore the prognosis of head and neck cancer patients. The detection of tumor cells, which circulate in the blood of cancer patients, known as circulating tumor cells and those that can be found in the bone marrow, called disseminated tumor cells (DTC) provides a diagnostic source especially for those patients at high risk of locoregional recurrence or distant failure. Circulating tumor cells (CTC) have been identified as a prognostic factor in different solid tumors. In head and neck squamous cell carcinoma, there are data for a similar prognostic relevance. The methods of detection of CTC/DTC, the role in diagnosis and follow-up in head and neck cancer are summarized in this review. Furthermore, the future technical and clinical challenges to be addressed to establish CTC/DTC in clinical routine are being critically discussed.     

Herpes zoster as an immune restoration disease in AIDS patients during therapy including protease inhibitors

A prospective study to evaluate the incidence of herpes zoster (HZ) as an immune restoration disease in patients with AIDS during highly active antiretroviral therapy (HAART) was conducted in a series of 115 patients diagnosed with AIDS initiated on HAART between 1 January 2000 and 31 July 2001. Of these, a single dermatomal HZ episode occurred in 14 (12%) patients within one and 15 months of HAART (median eight months). The HZ patients were similar to the non-HZ patients in age, sex, and HIV transmission risk factor, but had a more advanced disease. Compared with the baseline values, the viral loads significantly (P<0.01) decreased, while the mean CD4+ T-cell counts increased by almost four-fold (P<0.01) in both groups at the time of the HZ episode (or equivalent in non-HZ), but remained below 400/mL in the HZ patients. HZ during HAART is an immunopathological consequence of the improvement of the host immuneresponse, correlating with the beginning of immune restoration.     

Dyspepsia in Montenegrin chronic kidney disease patients undergoing hemodialysis: endoscopic and histopathological features

Purpose

The main purpose of this study was to analyze the characteristics of dyspepsia and contributing factors in Montenegrin maintenance hemodialysis patients.

Methods

The study included 43 patients undergoing hemodialysis with symptoms of dyspepsia and 40 control dyspeptic subjects with preserved kidney function. All subjects underwent an interview about dyspeptic symptoms, physical and biochemical examination, and upper gastrointestinal endoscopy with pathohistological analysis of biopsy specimens.

Results

Early satiety, bloating and heartburn were the most common symptoms in hemodialysis patients but without significant difference in frequency in relation to controls. Chronic kidney disease patients had statistically lower concentration of total proteins and albumin (p?<?0.001), as well lower BMI values (p?=?0.002). Despite this, no significant correlation of laboratory parameters with dyspeptic symptoms was found. Pathohistological examination indicated that the most common finding in hemodialysis patients was chronic active gastritis (58%), while chronic atrophic gastritis was significantly more common in dialytic patients (p?=?0.032). Patients on hemodialysis had more frequently atrophy of corpus mucosa, which was positively related to dialysis duration (p?=?0.001) and negatively related to pH values (p?=?0.004) and bicarbonate concentration (p?=?0.049). Helicobacter pylori was considerably more common in patients who underwent shorter time on hemodialysis (p?<?0.001) and had higher values of bicarbonate (p?=?0.037).

Conclusion

Maintenance hemodialysis patients are at risk for chronic gastric diseases that correlated with both dialysis vintage and duration.

     

F1 Cross‐Breed Between Susceptible BALB/c and Resistant Swiss mice Infected with Leishmania major Exhibit an Intermediate Phenotype for Lesion Sizes and Type 1 Cytokines but Show Low Level of Total IgG Antibodies

Our current understanding of the host immune response during leishmaniases largely derives from studies performed in mice due to the intrusive techniques required to study infected human patients. Swiss mice are highly resistant to Leishmania infections in concordance with observed response in humans, while BALB/c mice indicate a high‐susceptibility phenotype. Developing a cross‐breed between BALB/c and Swiss mice may have important consequences on disease development, immune responses and parasite killing, as yet, response of the cross‐breed to Leishmania infection is superficial. The aim of the present study was to determine disease course and immune responses in F₁ cross‐breed between BALB/c and Swiss albino mice infected with L. major. Three mice groups were infected intradermally with stationary‐phase L. major parasites with parental strains (BALB/c and Swiss albino) as controls. Lesion development was monitored weekly for 8 weeks and monocyte chemotactic protein (MCP‐1), macrophage inflammatory protein (MIP‐1α), interferon‐gamma (IFN‐γ) and IgG antibody quantified by enzyme‐linked immunosorbent assay. The data were analysed using one‐way analysis of variance and Tukey–Kramer test. Results indicated F₁ mice having intermediate lesion sizes, type 1 cytokine levels and footpad parasite loads as compared to the parental strains. However, the F₁ mice had low levels of IgG antibodies and parasite burden in the spleen. (P < 0.05). This study concludes that the F₁ cross‐breed between resistant and susceptible mice may be used as a requisite model to study the role of genetics in leishmaniases and perhaps other intracellular parasites.     

Correlation between age-related changes in open field behavior and plaque forming cell response in DA female rats

We investigated the relationship between immunological and behavioral changes during ageing in Dark Agouti female rats. Results showed that ageing was associated with decreased exploratory behavior and increased emotionality (open field test) and decreased pain perception (writhing assay), but not with altered depression-like behavior (forced swim test). The observed behavioral changes were paralleled with decreased innate immunity in middle-aged and old rats, as revealed by reduced peroxide production of peritoneal macrophages; and decreased specific immunity, measured by the plaque-forming cell response, in old rats in comparison with young rats. Correlation analyses between behavioral and immune parameters demonstrated a significant correlation between the lines crossed in the open field test and the plaque-forming cell response. Taken together, the demonstrated age-dependent association between exploratory behavior and specific immune response suggests a senescent decline of a common neuroimmune regulatory mechanism.